“Buffalo or dowager's hump” is an accumulation of fat on the upper back below the neck above and between the shoulder blades. This condition can occur with over secretion of cortisone by the adrenal gland, a condition called Cushing's syndrome. It is also a relatively common side effect of HIV and AIDS medications on many male patients. A dorsocervical lipectomy is a medical procedure to remove the fatty tissues forming the hump on the necks or upper backs of such patients. As with most lipectomy surgeries, post-surgical compression of the surgical site is desirable to mitigate swelling, and stretching of skin tissue due to fluid accumulation in the region under the skin where the fatty tissues have been removed.
Compression Therapy:
The application of sustained graduated compression is a key element in the treatment of all types of wounds, lipectomy surgical sites and ulcers caused by damaged or incompetent veins in the lower leg, etc. Compression hosiery is commonly used for wounds/ulcerations, located on a patient limb. Also, Elastic bands are typically fastened around encircling the torso of patients for compressing wound and surgical sites on the torso amenable to wrapping. For all other sites elastic bandages and multi-layer bandaging systems remain the principal mechanisms for effecting compression at a wound/surgery site.
Compression girdles are also used after liposuction procedures to help the skin at a surgical site reattach to the lower dermal layer. Doctors have used different types of compression wear for many years to help reshape patient body contours after sub-dermal intervention. Such garments are necessary because a human body naturally heals itself by swelling. Unfortunately, swelling can cause the improper reattachment of the skin to its new contours. Swelling can also break or dislocate wound healing tapes, sutures, staples or other devices.
The degree of compressive pressure required to optimize wound healing is a matter of some debate. The effectiveness of compression bandaging depends upon pressure provided and, this in turn, is determined by a number of factors including the physical and elastomeric properties of the fabric, the size and shape of the site, the skill or technique of the doctor/medical person applying the bandage and, most importantly, tension of the bandaging fabric post application.
Unlike stockings or tubular bandages, where the relationship between extension (a function of site diameter) and fabric tension is ‘pre-programmed’ into the product during the manufacturing process, the tension developed in most flat bandages during application is determined entirely by the person doing the bandaging. Studies have shown that the tension of bandages can vary significantly depending on the experience and skill of the person doing the bandaging. However, the tension achieved by an individual repeatedly performing a particular bandaging procedure can be quite consistent. Tension establishing applied pressures at the wound/surgery site often determines of the effectiveness of the treatment. If the pressure achieved is too low, the compression may be ineffective to prevent swelling and stretching. But if the pressure is excessively high there is a real possibility the resulting compression can damage tissue and cause necrosis over vulnerable areas.
Historically, attempts have been made to reduce the effects of bandaging variability by marking bandages with geometrical shapes that change from oblongs to squares when a particular level of extension (and therefore tension) has been applied to the fabric. This approach has been shown to significantly reduce variability and produce more consistent levels of compression.
Changes in Tension and Bandage Characteristics:
The use of application guides, however, fails to address a second problem associated with the use of extensible bandages, specifically the effect of changes of surface configuration of the bandaged area over time resulting in extension/contraction of the bandage and therefore changes in compression. The physical characteristics (elasticity) of the bandage fabric and its interaction with the underlying tissue surface (e.g. degree of adhesion) also can be very important in determining tension, and therefore applied pressure.
Elastomeric materials subjected to a sustained tensioning forces also gradually relax or yield over time, typically by 10–20% over a 24-hour period. Although most yield occurs in the first couple of hours, the process does continues thereafter, though at a slower rate. This process is termed ‘decay’ and is a problem with elastic compression bandages where the object is a high levels of compression in-situ over an extended period. In such bandaging schemes, to deliver a specific level of pressure after three days' post application will have to be applied with higher initial tension to allow for such ‘decay’.
Bandages that do not contain a significant amount of elastomer, but which rely upon heavily twisted textile yarns to provide a degree of elasticity, also exhibit decay and produce extensibility curves that show a very rapid change in tension for relatively small changes in extension. Bandages containing significant quantities of an elastomer perform much better in this respect. Elastomer containing are also better able to maintain applied tension, and ‘follow-in’ as the covered surface configuration shrinks while maintaining compression.
U.S. Pat. No. 6,296,618 to Gaber describes a pre/post surgical garment employing a flexible fabric fastening device. The garment provides an overall adjustable compression to specific parts of a patient's body covered by the garment. It also holds medically placed absorbent pads in desired locations and helps keep surgical sites sanitary.
U.S. Pat. No. 6,109,267 to Shaw et al. describes a therapeutic compression garment made of a unitary piece of flexible, foldable, light weight, Velcro-type hook-loop fabric. This compression garment is designed mainly for the leg and foot body parts.
There are other compression garments available in the market for post-surgical recovery purposes. However, most have just been manufactured of a simple single ply fabric-construction that fails to provide necessary compression to hold the skin in a desired position over sub-dermal surfaces.